Quality Update - Monitoring in a 'flash'

Winter 2011

Monitoring in a 'flash'

Date: January 20, 2011

Home care nurses use digital photography to bridge the gap between home and hospital.

During a blizzard in February 2010, home care nurse Lou Ann Rau needed help for a frail, elderly patient who had developed severe bedsores. But rather than having the woman make the arduous trip through the snow to an emergency room for consultation, the nurse clicked digital photos of the patient’s bone-exposing ulcers and sent them to a geriatrician at Johns Hopkins Bayview Medical Center.

The physician immediately arranged for the woman to be admitted to the hospital.

This episode is an example of how the Johns Hopkins Home Care Group has used digital photography since Oct. 2009 to better communicate with other providers and to quickly obtain help with complications that arise from caring for the wounds of adult patients.

As hospitals discharge patients with complex conditions earlier, there is a growing need for ways to better manage their home care. At any one time, roughly half of Home Care’s 400 adult patients have postsurgical wounds, ulcers or ostomies (surgically created openings to eliminate waste) that require professional attention.

If a wound looks problematic, a home care nurse will seek the patient’s consent to photograph it, then download it to a laptop and send it to the physician’s e-mail for a quick evaluation. When the condition is severe enough, a physician can arrange for the patient to be directly admitted into the hospital.

Rau, one of the Home Care Group’s authorities in wound, ostomy and continence nursing, helped to develop the wound-monitoring system. Lately, she has been working to set up a new heart-failure monitoring program that remotely tracks a patient’s vital signs and weight, all in an effort to reduce rehospitalizations.

“Daily monitoring will give us tighter control over some patients with tenuous conditions who home care nurses may only see one to two times weekly,” Rau says. “Whenever possible, we try to prevent rehospitalization and keep patients at home, where they prefer to be.”